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An audit of blood pressure control in clinical practice in Thailand
1Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sipbn@mahidol.ac.th
Insights
This study reveals suboptimal blood pressure control in Thai hypertensive patients, with many not reaching target goals. Increased use of multiple antihypertensive drugs was observed during follow-up.
Area of Science:
- Cardiology
- Public Health
- Clinical Pharmacy
Background:
- Hypertension management is crucial for cardiovascular disease prevention.
- Real-world data on blood pressure (BP) control in Thailand is limited.
- Current clinical practices and patient outcomes require evaluation.
Purpose of the Study:
- To assess BP control and antihypertensive treatment patterns in Thai hypertensive patients.
- To identify prevalent cardiovascular risk factors in this population.
- To evaluate changes in antihypertensive regimens over time.
Main Methods:
- A multi-center, cross-sectional study involving 1,259 hypertensive patients in Thailand.
- Data collection included demographics, cardiovascular risk factors, and antihypertensive drug use.
- BP measurements and treatment details were recorded at initial and last clinic visits.
Main Results:
- Only 44% of patients achieved a BP below 140/90 mm Hg; 12.3% of diabetic patients met the JNC 7 target of 130/80 mm Hg.
- Hypercholesterolemia (65.3%) and diabetes mellitus (27.7%) were the most common risk factors.
- The use of multiple antihypertensive drugs increased, with 66.2% of patients on two or more drugs by the last visit.
Conclusions:
- Blood pressure control in Thai hypertensive patients in clinical practice is suboptimal.
- There is an increasing trend towards using multiple antihypertensive agents.
- Further strategies are needed to improve hypertension management and achieve target BP goals.
Abstract:
To gain "real life" data on the BP control of hypertensive patients in clinical practice in Thailand, a multi-centre cross-sectional study was carried out. Demographic data, cardiovascular risk factors, and antihypertensive regimens were collected. A total of 1,259 patients were enrolled between October 2003 and December 2003, 924 cases from 6 regions of different levels of health care and 335 cases from 4 medical training centres and a tertiary care hospital in Bangkok. Eighty one percent of the patients, age ranged from 45 to 75 years (61.2 +/- 11.6). Forty four percent of patients in audit had a BP < 140/90 mm Hg and only 12.3% of DM patients had attained a JNC 7 recommended BP target of 130/80 mm Hg. Hypercholesterolaemia (65.3%) was the most prevalent risk followed by DM (27. 7%). Antihypertensive drug used at the initial visit compared with the last visit were ARB (0.9% vs 6.1%), ACE Inhibitors (30.1% vs 40.0%), beta-blockers (27.3% vs 46. 7%), CCBs (23.2% vs 37.7%), and diuretics (46.0% vs 53.5%). In addition, the numbers of antihypertensive drugs used at the initial visit compared with the last clinic visit were one drug (62.0% vs 33.0%), two drugs (29.7% vs 45.8%), three drugs or more (3.7% vs 20.4%), with an average of 1.3 +/- 0.6 vs 1.9 +/- 0.8 drugs per patient. Two thirds of patients (66.2%) were on 2 or more antihypertensive drugs. Among the type 2 DM, 5% had records of microalbuminuria, and 50.6% and 9.8% were receiving ACE Inhibitors and ARBs, respectively at the last clinic visit.
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